Safety and Validity of Laparoscopic Resection of the Primary Tumor in Cases of Symptomatic Stage IV Colorectal Cancer

抄録

Objective: We investigated the safety and validity of laparoscopic palliative resection of the primary lesion in cases of Stage IV colorectal cancer.
Patients and methods: We retrospectively compared patient characteristics, intraoperative and postoperative courses, and outcomes of patients with a symptomatic primary Stage IV colorectal cancer lesion treated either by laparoscopic surgery (n=41, LA group) or open surgery (n=18, OP group).
Results: Symptoms related to the primary lesion, particularly anemia and stenosis, did not differ significantly in prevalence between the two groups. Patients in both groups, but significantly more in the OP group (8 patients [44%] vs. 5 patients [12%], respectively; P=0.013) required bowel decompression. cT4b cancers existed only in the OP group (n=4) (P=0.006). Operation time was significantly longer in the LA group than in the OP group (218.5 [±69.4] vs. 142.5 [±60.5] minutes, respectively; P<0.001). Blood loss volume was significantly lower in the LA group (106.6 [±199.5] vs. 422.5 [±720.9] mL, respectively; P=0.0056). The hospital stay did not differ significantly (19.2 [±10.4] days vs. 20.1 [±6.3] days, respectively). Postoperative chemotherapy was initiated in 36 patients (87%) in the LA group and 13 patients (72%) in the OP group, without a significant difference in number, but the period preceding the chemotherapy was significantly shorter in the LA group (24.5 [±12.1] vs. 35.6 [±25.2] days, respectively; P=0.03). Median survival was significantly longer in the LA group than in the OP group (36 vs. 20 months, respectively; P=0.00167).
Conclusion: We conclude that laparoscopic resection of a primary, symptomatic Stage IV colorectal tumor is indicated in patients without bowel obstruction or after bowel decompression and when the rectal tumor has not invaded adjacent organs. Laparoscopic surgery appears to be safer than open surgery in such cases, and chemotherapy can be initiated earlier. The resulting prolonged survival reinforces the validity of this treatment.